The High Septon is usually elected from among the Most Devout themselves, though this is not an official requirement. In theory, the Most Devout are supposed to select the High Septon without outside interference. Oftentimes, however, the King of the Andals and the First Men, or other powerful political factions, can influence the Most Devout to elect their preferred candidate.

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In the A Song of Ice and Fire novels, the Most Devout are the ruling council of the Faith of the Seven. Like the High Septon, they used to be headquartered in Oldtown for centuries, but after the Targaryen Conquest they moved to the new capital city of King's Landing.

Given that George R.R. Martin has stated that the Faith of the Seven is loosely analogous to the medieval Catholic Church, the Most Devout are analogous to the College of Cardinals, just as the High Septon is analogous to the Pope.

The Most Devout has both male and female members, as both Septons and Septas are part of the council. Unlike the High Septon, members of the Most Devout are not required to give up their personal names. Moreover, they do not gain special new titles once they join the council (i.e. how the title of "Bishop" would change to "Cardinal"), and thus are simply called "Septon Raynard", "Septa Unella", etc., but not "Most Devout Raynard". There are not only seven members of the Most Devout, as might be assumed: it is mentioned that there are currently at least thirty members on the council.

There are several female members of the Most Devout at the time of the books, and there may have been a High Septa at some point in the past, but it has not been mentioned so far.

As the most senior and high ranking clergy of the Faith, they tend to be old. They are often perceived as somewhat corrupt, as powerful political factions frequently bribe them for special favors. Several have grown fat even as peasants starve in the slums of nearby Flea Bottom. Very powerful noble families, particularly the royal family, often influence whom they elect as the new High Septon.

The TV series has not yet officially introduced the Most Devout. The only time they have been mentioned so far is in HBO's In-Episode Guide for Season 2's "The Old Gods and the New", when the first High Septon prominently appears to bless Myrcella's departure. Casting reports, however, have indicated that the Most Devout will feature prominently in Season 5.